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Clinical Research

Long-term mortality in obese subjects undergoing malabsorptive surgery (biliopancreatic diversion and biliointestinal bypass) versus medical treatment


Background and aim

Aim of this study was to analyze long-term mortality in obese patients receiving malabsorptive bariatric surgery (BS)[biliopancreatic diversion (BPD) and biliointestinal bypass (BIBP)] in comparison to medical treatment of obesity.

Patients and methods

Medical records of 1877 obese patients [body mass index (BMI) > 35 kg/m2, aged 18–65 years, undergoing BS (n = 472, 111 with diabetes) or non-surgical medical treatment (n = 1405, 385 with diabetes), during the period 1999–2008 (visit 1)] were collected; non-surgical patients were matched for age, sex, BMI, and blood pressure, and life status and causes of death were ascertained through December 2016. Survival was compared across surgery patients and non-surgical patients using Kaplan–Meier plots and Cox regression analyses.


Observation period was 12.1 ± 3.41 years (mean ± SD). Compared to non-surgical patients, BS patients had reduced all-cause mortality (34/472 (7.2%) vs 181/1,405 (12.9%) patients, χ2 = 11.25, p = 0.001; HR = 0.64, 95% C.I. 0.43–0.93, p = 0.019). Cardiovascular and cancer causes of death were significantly less frequent in surgery vs no-surgery (HR = 0.26, 95% C.I. 0.09–0.72, p = 0.003; HR = 0.21, 95% C.I. 0.09–0.45, p < 0.001, respectively).


Patients who have undergone BPD and BIBP have lower long-term all-cause, cardiovascular-caused and cancer-caused mortality compared to non-surgical medical weight-loss treatment patients. Malabsorptive bariatric surgery significantly reduces long-term mortality in severely obese patients.

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The authors wish to thank Dr. Antonio G. Russo, Osservatorio Epidemiologico, ATS, Città Metropolitana di Milano, for the precious help in identifying causes of death of patients in the study. The LAGB10 working group includes people from Ospedale San Paolo (Annamaria Veronelli MD, Barbara Zecchini BSc, Ahmed Zakaria PhD, Francesca Frigè BSc, Luca Rossetti MD, Alberto Benetti MD, Maurizio Cristina MD, Ermanno Mantegazza BSc, Marco Fanchini BSc, Alberto Morabito PhD, Antonio E. Pontiroli MD), from IRCCS Policlinico (Enrico Mozzi MD), Ospedale San Raffaele (Alessandro Saibene MD, Michele Paganelli MD, Paola Vedani MD), from Istituto Clinico Sant’Ambrogio (Giancarlo Micheletto MD, Alessandro Giovanelli MD), from Istituto Multimedica (Valerio Ceriani, Chiara Osio), from Ospedale Civile, Magenta (Giuliano Sarro MD), from Istituto Humanitas Gavazzeni (Italo Nosari MD), and from the Health Districts (Maria Grazia Angeletti MD, Mariangela Autelitano MD, Luca Cavalieri d’Oro MD, Piergiorgio Berni MD, Antonio G. Russo MD).

Author contributions

VC, GS, CO, GM, AG performed all bariatric procedures, searched data, contributed to discussion; ASZ, MF, IN searched data, prepared the database, contributed to analysis, contributed to discussion; AM performed statistical analysis, contributed to discussion; AEP planned the research, contributed to discussion, wrote the manuscript. All authors read and approved the final manuscript.


Università degli Studi di Milano, Ospedale San Paolo, Istituto Multimedica, Ospedale di Magenta, Istituto Humanitas Gavazzeni, INCO-Istituto Clinico Sant’Ambrogio. Grant “Ricerca Corrente” to Istituto Multimedica from Ministero della Salute (Ministry of Health), Italy

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Correspondence to Antonio E. Pontiroli.

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Ceriani, V., Sarro, G., Micheletto, G. et al. Long-term mortality in obese subjects undergoing malabsorptive surgery (biliopancreatic diversion and biliointestinal bypass) versus medical treatment. Int J Obes 43, 1147–1153 (2019).

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